Monday, June 15, 2009

Thinking Point: President Obama At the AMA.:Clickable A4,A3

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President Obama delivered a 50-minute address to the American Medical Association about the need for health care reform at a convention of the big doctors' group in Chicago. USA TODAY's Judy Keen is in Chicago at the convention and we'll be covering reaction in our blog. Below is our live blog of the president's address. All times are ET

1:07: Obama says his proposals will save about $950 billion, extend the life of the Medicare Trust Fund by seven years and reduce Medicare premiums by about $43 billion over the next decade.

1:06: Obama says he can get another $313 billion in Medicare and Medicaid spending by making the programs more efficient; save $106 billion by lowering the number of uninsured patients on hospital rolls and $75 billion by doing a better job of purchasing drugs.

1:05: Obama wants to speed to market generic biologic drugs, used to treat diseases like anemia. He says the government can get save $30 billion by getting a better deal for poorer seniors while "asking our well-off seniors to pay a little more for drugs."

1:03: The president wants to change Medicare reimbursements to prevent patients from being released from hospitals before they are ready. Right now, almost 20% of Medicare patients are readmitted within a month after being released from hospitals because they aren't getting the care they need, Obama says.

1:01: Obama says he'll pay the bill for health care by ending overpayments to Medicare Advantage. He says that cutting this "subsidy to insurance companies" will save $177 billion over the next decade.

1:00: "Making health care affordable for all Americans will cost somewhere on the order of $1 trillion over the next 10 years," Obama says. While that's "real money -- even in Washington," he quips, it's "less than we are projected to spend on the war in Iraq"

12:56: Big cheers for this: "We need to end the practice of denying coverage on the basis of preexisting conditions," the president says. "The days of cherry-picking who to cover and who to deny -- those days are over,". . .

12:51 p.m. The president directly confronts an issue on which the AMA has opposed him. Health care reform must include a government-run insurance option to "force waste out of the system and keep the insurance companies honest," he says. Evidently not all members of the doctors' group agrees with the AMA official position against the so-called public option, because the president is getting some applause.

12:50 p.m. Beyond economic arguments, there's a moral imperative for achieving health care reform, the president argues: "We are a nation that cares for its citizens. We are a people who look out for one another. That is what makes this the United States of America. We need to get this done."

12:48 p.m. Extending health insurance to all Americans is "in all of our economic interests," the president says, because each time an uninsured patient shows up at an emergency room "it's reflected in higher taxes, higher premiums and higher health care costs."

12:43: Obama is trying again to reassure doctors he's not going to impose a government bureaucracy on them. "I will listen to you and work with you to pursue reform that works for you," the president says, getting his longest ovation so far.

12:42: Obama moves to preempt arguments that his plan will put the government between doctors and their patients. "Let me be clear," he says. "Identifying what works is not about dictating what kind of care should be provided."

12:41: Less than 1% of the nation's health care spending goes to determining which treatments are most effective., the president says: "As a result, too many doctors and patients are making decisions without the benefit of the latest research."

12:40: "We need to rethink the cost of a medical education and do more to reward medical students who choose a career as primary care physicians and who choose to work in underserved areas instead of a more lucrative path," the president says, prompting another ovation.

12:39: "You didn't enter this profession to be beancounters and paper-pushers. You entered this profession to be healers - and that's what this health care system should let you be," the president tells the doctors, triggering some of the most enthusiastic applause so far.

12:37: Obama says the health insurance system "rewards the quantity of care rather than the quality of care" by pushing doctors "to see more and more patients even if you can't spend much time with each." The audience is listening very quietly. No applause.

12:36: The existing health care system "spends vast amounts of money on things that aren't making our people any healtier," Obama says.

12:35: Efforts to streamline recordkeeping and improve Americans' health habits "will only make a dent in the epidemic of rising costs" in the health care system, the president concedes.

12:34: Obama praises a program available to employees of the supermarket chain Safeway. It provides lower insurance premiums for employees who get regular medical screenings to prevent disease.

12:33: Americans need to "take more responsibility for our health," says the president. "That means quitting smoking," says the commander-in-chief, who is struggling with that himself. Obama also is promoting more exercise and less junk food. He touts the White House vegetable garden while conceding "Michelle has done most of the work."

12:31: The president says the medical system should computerize Americans' health records. As Newt Gingrich has rightly pointed out -- and I do not quote Newt Gingrich that often," says the president, prompting a big guffaw from the audience, "we do a better job tracking a FedEX package in this country that we do tracking a patient's health records."

12:29: Obama says health care reform will enable the nation to "stop spending tax dollars to prop up an unsustainable system and start investing those dollars in innovations and advances that will make our health care system and our economy stronger."

12:28: "No matter how we reform health care, we will keep this promise: If you like your doctor, you will be able to keep your doctor. Period."

12:27: "The moment is right for health care reform," the president says, "this is an historic opportunity we've never seen before and may not see again."

12:25 p.m. "What makes this moment different," Obama says, is that more interest groups are openly acknowledging the need for reform. "Ultimately, everyone will benefit," he says.

12:24 p.m. Obama accuses some opponents of using "fear tactics" that portary any effort to reform the health care system "as an attempt to, yes, socialize medicine."

12:23 p.m.: Obama acknowledges some doctors in the audience might be skeptical of his plan. "There's a fear of change -- a worry that we may lose what works about our health care system while trying to fix what doesn't," he says.

12:22 p.m. "Health care is the single most important thing we can do for America's long-term fiscal health," Obama says.

12:20 p.m. The president is defending his effort to enact sweeping health care reform in the midst of a recession. "I'd love to be able to defer these issues, but we can't," Obama says. "Let there be no doubt: The cost of inaction is greater." Failure to act will mean "a lower standard of living for all Americans," he adds.

12:19 p.m.: Obama says one-third of small businesses have dropped health insurance coverage for workers since the early 1990s, and says health costs helped drive big companies into bankruptcy too. "If we do not fix our health care system, America may go the way of GM," he says.

12:18 p.m.: "Our costly health care system is unsustainable for doctors," adds Obama. He quotes Michael Kahn, a New Hampshire physician, saying he spends 20% of his time on insurance paperwork.

12:16: Rising cost of health care is "unsustainable for the United States of America," Obama says. He calls it "a threat to our economy."

12:15 p.m.:The president says that in the effort to pull the nation out of the recession, "one essential step in our journey is to control the spiraling cost of health care in America."

Nancy Nielsen, the AMA’s outgoing president, and J. James Rohack, who will become the group’s president tomorrow, are holding a press conference to respond to the speech. Here’s what they’re saying.

1:43 Nielsen speaks. She says the AMA was delighted that the president came to address the group. “Like the president, the American Medical Association is committed to covering all Americans.” Everybody deserves affordable, high-quality coverage. The AMA has been working on this issue.

1:45 “The president was very warmly received,” she adds, and starts to take questions. (The audio is difficult to hear, but we’ll do the best we can.)

1:46 The group was “thrilled” that this was the first Democratic president to talk about liability reform.

1:47 Over the next days, the AMA will figure out the way it can best help the president reach the goals they share, which is affordable health insurance for all Americans.

1:48 Rohack speaks. Both the president and the AMA share the goal of all Americans having affordable health coverage and to not have the emergency room be the access point for health care. The AMA is also excited about the president’s emphasis on prevention.

1:49 Nielsen speaks. On malpractice-liability reform, the AMA knew Obama was opposed to a cap on damages. “But what we were very pleased about was that he is open to considering options that would lower the cost of defensive medicine.” He acknowledged the issue, which pleased the AMA.

1:50 Rohack speaks. Because of the advances of medical science, life expectancy is 10 years longer than when Medicare was first started. There’s improved technology, improved ways to take care of patients. But 50 million people don’t have affordable health insurance. We’re committed to trying to reform the system.

1:52 “We are at a watershed moment in our country,” Rohack says. He echoes the president’s emphasis on the importance of health care to the economy and again talks about preventive care.

1:55 Nielsen speaks. The AMA is committed to Americans having choice, and the president talked about that today as well. Choice of coverage, choice of doctors.

1:56 On the public plan, Nielsen says the group has tried to be “open to whatever possibilities are actually in play, being considered in Congress, rather than reacting to a label.”

1:58 On the idea of a health-insurance exchange, Rohack says the principle of “choice” is very important. Right now, Americans have a hard time finding different options. It is cumbersome to search for a plan. Rohack talks in a positive light about the choices that federal employees have. “It was clear that the president was also signaling his awareness that the patient-physician relationship is very important,” while at the same time having options for insurance is important. The exchange is a model.

2:00 Nielsen speaks. On comparative effectiveness, the president said that people think this means dictating what people have to do. He said that wouldn’t be the case. Getting good information that doctors and patients need — that’s what everybody agrees on.

2:03 Rohack says the president’s coming there today recognizes the important role that doctors play in health care. The AMA represents all doctors in the U.S. His coming recognizes that doctors are there for their patients, and if doctors don’t believe reform will be good for their patients, we’ll let our patients know.

2:05 Nielsen says the president indicated that putting a label on something before knowing what it is, is not the best way to handle this debate. Don’t look at labels, don’t let fear-mongering or rhetoric get in the way of plans we haven’t yet seen. We have to get to the goal of health care for all Americans. “It is the best chance and maybe the last chance in a decade.” We also want to get rid of the labels and wait until you hear what people are talking about.

2:07 Asked what would make any plan unpalatable to the AMA, Nielsen says it would be taking away decisions from the patients and their doctors.

2:08 Rohack says the president signaled a recognition of a crisis and a need to solve it. He echoes the president’s point about the difficulty that patients with pre-existing conditions have getting health insurance. Doctors reacted enthusiastically to the president when he said that problem needed to be solved.

2:09 On primary care, Rohack says that systems that seem to control health-care costs the best, nationwide and internationally, they have a place where a patient has a “home” and can get coordinated care. Primary care is extremely important, but there are also specialties, such as general surgery, that are also in short supply. We have an opportunity to “deal with this burden of debt that the average student comes out with.” They’re choosing specialties based on their ability to pay off that debt. We want to work with the president to achieve a common goal of affordable health insurance and a work force that can provide them with care.

2:13 Nielsen says that the reality is that doctors make a good living, by and large. But they’ve also had difficulty keeping offices open. They have difficulty paying rent and paying their employees. Students come out of medical school and residency with $140,000 in debt. We have to get back to doing what we do best: caring for patients.

2:14 Rohack talks about the administrative burden of dealing with a lot of different insurance companies.

2:15 Rohack talks about Obama’s mention of hospital readmissions. Some of this has to do with a law that prevents doctors from providing IT services for hospitals. Patients go home and they don’t have their records. “The reality is we don’t talk to each other, still,” he says, referring to hospitals and doctors. Different organizations have electronic systems, but those systems don’t talk to each other, and that contributes to readmissions. The AMA is committed to working on this, and is doing so right now. Interoperability standards are key.

2:18 On malpractice reform, Rohack says the president showed he knows that part of the health-care cost problem is due to defensive medicine. We are willing to have best practices, but unless we have protection in a court room for not ordering a test, we are going to order the tests. Doctors need a “safe harbor.” That will help cut unnecessary costs, including defensive medicine.